MEDICINE I

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Patient presents with critical ischemia, rest pain and tissue loss on the
lower extremities because of arterial occlusion. What is the most
probable ankle-brachial index of the patient?
a. > 1
c. < 0.9
b. < 0.6
d. < 0.3
The following are true in examining the Jugular venous pulse except:
a. Right Jugular vein is used best
b. Simultaneous palpation of the left carotid artery aids in relating
the venous pulsation to their timing in cardiac cycle
c. In decreased venous pressure, it may be necessary to
elevate trunk further to as much as 90 degrees
d. Tangential lighting is used to expose the pulsations
Positive wave produced by the bulging of the tricuspid valve into the RA
during RV isovolumetric systole and by the impact of the carotid artery
adjacent to the jugular vein?
a. A wave
c. v wave
b. C wave
d. x descent
Results from the increasing volume of blood in the RA during
ventricular systole when the tricuspid valve is closed?
a. A wave
c. v wave
b. C wave
d. x descent
Positive presystolic wave produced by venous distention due to RA
contraction?
a. A wave
c. v wave
C wave
d. x descent
All are true in estimating CVP except:
a. Right internal jugular vein is the best vein used
b. Right external jugular vein is the best vein used
c. Sternal angle is used as reference point
d. Normally it measures less than 3 cm
Most common cause of positive abdominojugular reflux test?
a. Right sided HF
c. Left side HF
b. Cardiac tamponade d. pulmonary edema
The following produce accentuated S1 except:
a. Tachycardia
c. short PR interval
b. High cardiac output d. long PR interval
S2 normally splits into audibly distinct A2 and P2 components during:
a. Inspiration
c. left decubitus position
b. Expiration
d. valsalva maneuver
Best heard with bell of the stethoscope:
a. S1 & S2
c. S3 & S4
b. Mitral regurgitation d. friction rubs
What is the effect of Valsalva maneuver in the length and intensity of
heart murmurs of patients with HCM or MVP?
a. Increase
c. no effect
b. Decrease
d. variable
What is the effect of squatting in the intensity of heart murmurs of
patients with HCM or MVP?
a. Increase
c. no effect
b. Decrease
d. variable
In valvular aortic stenosis, the murmur may disappear over the sternum
and reappear at the apex leaving a false impression that mitral
regurgitation is present. What is this phenomenon?
a. Mammary souffl
c. Gallavardin effect
b. Carvallo Sign
d. Stills murmur
Which of the following will produce a continuous murmur?
a. PDA
c. ventricular septal defect
b. Mitral stenosis
d. left atrial myxoma
Retrosternal pain which lasts 10-20 mins perceived as heaviness,
pressure or squeezing over the chest, often associated with
diaphoresis, dyspnea and nausea, which occurs even at rest and is
unrelieved by nitroglycerin?
a. Stable angina
c. esophageal spasm
b. Unstable angina
d. pulmonary embolism

16. Sharp, knifelike pain, aggravated by inspiration or coughing which

result from lung disease that damage and cause inflammation of the
pleura of the lungs?
a. Pneumonia
c. pericarditis
b. Pneumothorax
d.pulmonary embolism
17. Sudden onset of pleuritic chest pain and respiratory distress which may
occur without a precipitating event in persons without lung disease or
as a consequence of underlying lung disorder?
a. Pneumonia
c. pericarditis
b. Pneumothorax
d.pulmonary embolism
18. Abrupt onset of unrelenting, tearing or ripping sensation, sometimes
knifelike, often radiating to the back?
a. Pericarditis
c. aortic dissection
b. Herpes zoster
d. pulmonary embolism
19. Sharp or burning chest pain that has a dermatomal distribution?
a. Pericarditis
c. chicken pox
b. Herpes zoster
d. syphilis
20. Retrosternal pain lasting more than 30 mins perceived as heaviness or
pressure over the cheast and unrelieved by nitroglycerin?
a. Stable angina
c. acute MI
b. Aortic stenosis
d. pulmonary embolism
21. Type of syncope occurring during cough, micturition, deglutition and
defecation?
a. Glossopharyngeal neuralgia
c. neurocardiogenic syncope
b. Reflex syncope
d. situational syncope
22. Associated with both sympathetic withdrawal (vasodilatation) and
increased parasympathetic activity (bradycardia)?
a. Vasovagal syncope
c. pure autonomic syncope
b. Vasodepressor syncope d. orthostatic syncope
23. Syncope that is gradual in onset, precipitated by hot environment,
extreme fatigue, pain, hunger or stress where sphincter control is
maintained and relieved by lying down?
a. Neurocardiogenic
c. carotid sinus hypersensitivity
b. Psychogenic
d. situational syncope
24. Syncope that is not accompanied by facial pallor and not relieved by
recumbency but can be reproduced by hyperventilation?
a. Hysterical fainting
c. Anxiety attacks
b. Stokes-Adams Syndrome d. Wolff-Parkinson-White syndrome
25. The following results from ventilatory pump dysfunction except:
a. Kyphoscoliosis
c. anemia
b. GBS
d. asthma
26. The following results from controller dysfunction except:
a. Pregnancy
c. high altitude
b. Pneumonia
d. drug induced
27. The following are low cardiac output dyspnea except:
a. Anemia
c. nonischemic cardiomyopathies
b. Coronary artery dse
d. myocardial ischemia
28. Which of the following results in normal cardiac output dyspnea?
a. CAD
c. cardiovascular deconditioning
b. LR intracardiac shunt d. systolic dysfunction
29. A type of pulmonary edema with normal hydrostatic pressures, and
results from damage to pulmonary capillary lining?
a. Cardiogenic
c. physiologic
b. Noncardiogenic
d. hydropericardium
30. In a non-smoker who has normal chest readiograph and is not taking
ACE inhibitor, the most common causes of chronic cough are the
following except:
a. Infection
c. postnasal drip
b. Asthma
d. GERD
31. Acute cough lasts for about:
a. <4 weeks
c. <2 weeks
b. <3 weeks
d. <1 week
32. Chronic cough lasts for about:
a. >5 weeks
c. >7 weeks
b. >6 weeks
d. >8 weeks
33. Massive hemoptysis involves expectoration of how much blood over a
24 hour period?

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a. > 25 mL
c. >75 mL
b. > 50 mL
d. >100 mL
Most common cause of respiratory hypoxia?
a. V/Q mismatch
c. LR shunting
b. anemia
d. asthma
For cyanosis to occur, reduced Hb should be elevated to how much?
a. > 2 g/dL
c. > 8 g/dL
b. >5 g/dL
d. >10 g/dL
Results from arterial desaturation?
a. Central cyanosis
c. clubbing
b. Peripheral cyanosis
d. hypoxia
Selective bulbous enlargement of the distal segments of the fingers due
to proliferation of connective tissues, particularly on the dorsal surface?
a. Callous formation
c. Reynauds phenomenon
b. Clubbing
d. arthritis
Unusual awareness of heartbeat that may be intermittent thumping,
pounding or fluttering sensation?
a. Palpitation
c. skip beats
b. Angina
d. panic attack
Most common cause of palpitation?
a. Cardiac
c. miscellaneous
b. Psychiatric
d. unknown
Gross or generalized edema?
a. Ascites
c. myxedema
b. Hydrothorax
d. anasarca
Which of the following promotes movement of fluid from the vascular to
the extravascular space?
a. Capillary hydrostatic pressure
b. Capillary colloid oncotic pressure
c. Interstitial hydrostatic pressure
d. B & C
Multiple peripheral arteriovenous fistulae result in reduced effective
systemic perfusion and effective arterial blood volume thereby
enhancing edema formation?
a. Beri beri heart disease c. Edema of Nephrotic syndrome
b. Refeeding edema
d. Edema of Cirrhosis
Apical impulse is normally found where?
a. 5th RICS, 7-9cm lateral to midaxillary line
b. 5th LICS, 7-9cm lateral to midsternal line
c. 6th LICS, midclavicular line
d. 6th LICS, anterior axillary line
LV hypertrophy has a PMI measuring:
a. > 1.5 cm
c. > 2.5 cm
b. > 2.0 cm
d. > 3.0 cm
Most prominent palpable impulse at xiphoid or epigastric area?
a. LV hypertrophy
c. pulmonary HPN
b. RV hypertrophy
d. cardiac tamponade
Which of the following is closed during diastole?
a. Mitral valve
c. semilunar valve
b. Tricuspid valve
d. fossa ovale
Borders of Precordium
a. 2nd to 5th ICS from right border of sternum to left
midclavicular line 5th to 6th ICS
b. 2nd to 5th ICS from right border of sternum to left midclavicular line
6th to 7th ICS
c. 3rd to 5th ICS from right border of sternum to left midclavicular line
5th to 6th ICS
d. 3rd to 5th ICS from right border of sternum to left midclavicular line
6th to 7th ICS
At HR < 100 bpm, what is the relationship of diastole with regards to
systole?
a. Greater
c. equal
b. Lesser
d. no relationship
At HR > 100 bpm, what is the relationship of diastole with regards to
systole?
a. Greater
c. equal
b. Lesser
d. no relationship

50. Occurs at the onset of systole, during which a contraction is occurring

in the ventricles but there is no emptying?
a. rapid filling
c. ejection
b. isovolumetric contraction
d. isovolumetric relaxation
51. At the end of systole, ventricular relaxation begins suddenly and the
elevated pressures in the large arteries snaps the semilunar closed.
The ventricular muscles continues to relax even though ventricular
volume does not change?
a. Rapid filling
c. ejection
b. Isovolumetric contraction d. isovolumetric relaxation
52. The following increases the preload except:
a. Inspiration
c. exercise
b. Exhalation
d. increase venous return
53. Blood pressure is the product of?
a. CO & TPR
c. SV & TPR
b. CO & SV
d. CO, SV & TPR
54. The following are true except:
a. Internal jugular pulsation is rarely palpable
b. Height of carotid pulsation is not affected by inspiration
c. Internal jugular pulsation is eliminated by light pressure
d. Carotid pulsation are soft, biphasic, undulating quality with 2
elevations and 2 troughs per heart beat
55. Increased arterial pulse with a double systolic peak
a. Bisferiens pulse
c. bigeminal pulse
b. Pulsus alternans
d. paradoxical pulse
56. Palpable decrease in the pulse amplitude on quiet respiration, SBP
decreases by >10 mmHg during inspiration
a. Bisferiens pulse
c. bigeminal pulse
b. Pulsus alternans
d. paradoxical pulse
57. Humming vibration that feel like the throat of a purring cat
a. Bruit
c. heaves
b. Lift
d. thrill
58. Soft decreascendo diastolic murmurs of aortic insufficiency is
accentuated in which of the following maneuver?
a. Supine
c. standing
b. Left lateral decubitus
d. leaning forward after exhalation
59. Opening snap, S3 and diastolic rumble of mitral stenosis are
accentuated in which of the following maneuver?
a. Supine
c. standing
b. Left lateral decubitus
d. leaning forward after exhalation
60. Decreased P2 intensity
a. Pulmonary hypertension c. calcific aortic stenosis
b. Pulmonic stenosis
d. systemic hypertension
61. Increase A2 intensity
a. Pulmonary hypertension c. calcific aortic stenosis
b. Pulmonic stenosis
d. systemic hypertension
62. Occur shortly after S1 coincident with opening of the aortic and
pulmonic valves. Usually high pitch, sharp and with clicking quality
a. Early systolic ejection sound c. systolic clicks
b. Opening snap
d. Atrial Gallop
63. Very early diastolic sound produced by opening of stenotic mitral valve
a. Early systolic ejection sound
c. systolic clicks
b. Opening snap
d. atrial gallop
64. Occurs just before S1, dull and low in pitch which is due to increased
resistance to ventricular filling following atrial contraction
a. Ventricular gallop
c. summation gallop
b. Opening snap
d. atrial gallop
65. Holosystolic murmur at the apex, medium to high pitch that is soft to
loud in intensity with apical thrill.
a. Mitral regurgitation
c. ventricular septal defect
b. Tricuspid regurgitation
d. aortic regugitation
66. Pansystolic murmur heard over the 3rd, 4th and 5th LICS, that is often
loud and high pitch.
a. Mitral regurgitation
c. ventricular septal defect
b. Tricuspid regurgitation
d. aortic regugitation
67. Turbulent blood flow generated by ventricular ejection of blood into the
aorta with no underlying cardiovascular disease

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a. Innocent mumur
c. aortic stenosis
b. Physiologic murmur
d. aortic regugitation
Midsystolic Murmur heard over the right ICS, medium to high pitch,
crescendo decrescendo type.
a. Innocent mumur
c. aortic stenosis
b. Mitral regurgitation
d. aortic regurgitation
Diastolic murmur heard over the 2nd to 4th ICS, high pitch that is blowing
decrescendo type.
a. Innocent murmur
c. aortic stenosis
b. Mitral regurgitation
d. aortic regurgitation
Paradoxical Angina occurring during rest but usually not during
exervise caused by coronary artery spasm.
a. Stable Angina
c. Pritzmetal Angina
b. Atypical angina
d. Unstable Angina
Abdomen with General distented contour with inverted umbilicus
a. Chronic ascites
c. obesity
b. Umbilical hernia
d. malnutrition
Normoactive bowel sound
a. <5/min
c. <5 / 5 min
b. 5 34 / min
d. 5-34 / 5 min
Decreased bowel sound
a. Diarrhea
c. ileus
b. Early pyloric obstruction d. early intestinal obstruction
Frequent bowel sound due to early intestinal obstruction
a. Tinkles
c. succusion splash
b. Rushes
d. peritoneal friction rub
Pain occurring at the site of pressure
a. Blumbergs sign
c. markles sign
b. Rovsings sign
d. cullens sign
Stand on toes and suddenly relax causing heels to hit the floor and
eliciting pain
a. Blumbergs sign
c. markles sign
b. Rovsings sign
d. cullens sign
Place hand above patients knes and raise his thigh to elicit pain
a. Rebound tenderness
c. psoas sign
b. Jar tenderness
d. obturator sign
Inspiratory arrest seen in acute cholecystitis upon placing right hand on
liver border
a. Middleton maneuver
c. ballotment
b. Murphys sign
d. markles sign
Normal liver span (mid clavicular line)
a. 4-8 cm
c. 6 10 cm
b. 6-12 cm
d. 8 -12 cm
Meatus of penis on ventral surface
a. Hypospadias
c. phimosis
b. Epispadias
d. hydrocele
Enlargement of spermatic cord that feels like a bag of worms
a. Hypospadias
c. phimosis
b. Epispadias
d. varicocele
Steady and aching abdominal pain accentuated by pressure changes
in the peritoneum
a. Peritonitis
c. cholangitis
b. Pancreatitis
d. colonic obstruction
Dull suprapubic pain usually low in intensity associated with restless of
no specific complain
a. Urinary bladder obstruction c. pacreatitis
b. Bilary tree obstruction
d. peritonitis
Occur in dieases that injure sensory nerves which is burning in
character, limited to the distribution of the peripheral nerve and
demonstration of irregularly spaced cutaneous pain spots
a. Causalgic pain
c. functional cause
b. Spinal nerve pain
d. metabolic abdominal crisis
Sensation of lump lodged in the throat with no difficulty encountered
whens swallowing
a. Aphagia
c. phagophobia
b. Globus pharyngeus
d. odynophagia
Inhibitory innervation of both esophageal body and LES is impaired
a. Aphagia
c. achalasia

b. Globus pharyngeus
d. diffuse esophageal spasm
87. Inhibitory innervation only to the esophageal body is impaired
a. Aphagia
c. achalasia
b. Globus pharyngeus
d. diffuse esophageal spasm
88. Rare disorder of unknown etiology that produces periodic discrete
episodes of relentless nausea and vomiting, common in children.
a. Intestinal pseudoobstruction
c. functional vomiting
b. Chronic idiophatic nausea d. cyclic vomiting syndrome
89. Severe form of nausea of pregnancy
a. Hyperemesis gravidarum c. hyperemesis neonatarum
b. Functional vomiting
d. idiopathic nausea
90. Cyclical event which characterizes motility of SI during fasting
a. MMC
c. HAPC
b. Phasic contraction
d. colonic tone
91. Average transit time of the ascending and transverse colon
a. 10 h
c. 20 h
b. 15 h
c. 25 h
92. Average transit time of descending colon
a. 1 h
c. 3 h
b. 2 h
d. 4h
93. Causes diarrhea after eating chicken except
a. Salmonella
c. campylobacter
b. Shigella
d. citrobacter
94. Causes diarrhea from eating mayonnaise
a. Gardia
c. rotavirus
b. S. aureus
d. bacillus cereus
95. Most common cause of infectious diarrhea in institutionalized people
a. C. difficile
c. shigella
b. Giardia
d. ETEC
96. Diarrhea associated with marked vomiting and minimal or no fever
a. Preformed bacterial toxin c. yersina
b. Entamoeba histolytica
d. Giardia
97. Metastatic gastrointestinal carcinoid tumors
a. Secretory diarrhea
c. steatorrheal diarrhea
b. Osmotic diarrhea
d. dysmotility diarrhea
98. Carbohydrate malabsorption
a. Secretory diarrhea
c. steatorrheal diarrhea
b. Osmotic diarrhea
d. dysmotility diarrhea
99. Tropical Sprue
a. Secretory diarrhea
c. steatorrheal diarrhea
b. Osmotic diarrhea
d.inflammatory diarrhea
100. Eosinophilic gastroenteritis
a. Secretory diarrhea
c. steatorrheal diarrhea
b. Osmotic diarrhea
d. inflammatory diarrhea
101. Hyperthryoidism and cardinod syndrome
a. Secretory diarrhea
c. inflammatory diarrhea
b. Osmotic diarrhea
d. dysmotility diarrhea
102. Black tarry foul smelling stool
a. Hematemesis
c. hematochezia
b. Melena
d. occult GI bleeding
103. Most common cause of of lower gastrointestinal bleeding
a. Haemorrhoids
c. neoplasm
b. Meckels diverticulum
d. vascular ectasia
104. Presence of scleral icterus indicates a serum bilirubin of at least:
a. 2.5 mg/dl
c. 3.5 mg/dl
b. 3.0 mg/dl
d. 4.0 mg/dl
105. Reacts after the addition of alcohol in van der bergh reaction
a. Direct bilirubin
c. indirect bilirubin
b. Total bilirubin
d. urine bilirubin
106. Unconjugated Hyperbilirubinemia where Patients live into adulthood
with serum bilirubin levels from 6-25 mg/dl
a. Criggler najjar I
c. Gilbert syndrome
b. Criggler Najjar II
d. dubin Johnson syndrome
107. Unconjugated hyperbilirubinemia due to reduced bilirubin UDPGT
activity with levels almost always 6 mg/dl
a. Criggler najjar I
c. gilbert syndrome
b. Criggler najjar II
d. dubin Johnson syndrome
108. AST:ALT ratio of 2:1 with AST rarely exceeding 300 U/L
a. Wislons disease
c. acute viral hepatitis

b. Alcoholic hepatitis
d. autoimmune hepatitis
109. Aminotransferases >500 U/L with ALT greater than or equal to AST
a. Wilson disease
c. acute viral hepatitis
b. Alcoholic hepatitis
d. autoimmune hepatitis
110. Succussion splash is present in
a. Dilated hollow viscus
c. ulcer
b. Ascites
d. pancreatitis
111. Prominent abdominal venous patter with direction of flow downward
toward umbilicus
a. Portal HPN
c. SVC obstruction
b. IVC obstruction
d. carotid obstruction
112. Prominent abdominal venous pattern with direction of flow away from
umbilicus
a. Portal HPN
c. SVC obstruction
b. IVS obstruction
d. carotid obstruction
113. Mean hematocrit value for adult males
a. 42%
c. 52%
b. 47%
d. 57%
114. Signs of hypovolemic shock occurs with how much blood loss
a. 10-15%
c. >30%
b. 25%
d. >40%
115. Common cause of hypoproliferative anemia
a. Inadequate EPO stimulation c. blood loss

b. Folic acid deficiency

d. heme synthesis abnormalities
116. Common cause of maturation disorder
a. Marrow damage
c. folic acid deficiency
b. Inadequate EPO stimulation
d. blood loss
117. Hematocrit levels of ___ in men and ___ in women may be abnormal
a. >45%, >50%
c. >60%, >55%
b. >50%, >45%
d. >55%, >60%
118. Borders of Traubes Space except
a. 6th rib superiorly
c. left costal margin inferiorly
b. Left midaxillary line laterally
d. diaphragm superiorly
119. Azotemia >3 months, with prolonged symptoms of signs of eremia.
Renal osteodystrophy and bilateral reduction in kidney size
a. Rapid progressive renal failure
b. Acute nephritis
c. Chronic renal failure
d. Nephrotic syndrome
120. Proteinuria, Hypoalbuminemia, edema and hyperlipidemia
a. Nephrotic syndrome
c. nephrolithiasis
b. Acute nephritis
d. acute renal failure
121. < 500 ml in 24 hrs urine output
a. Oliguia
c. anuria
b. Azotemia
d. nonoliguria